LDL adsorption improves the response of focal glomerulosclerosis to corticosteroid therapy

We investigated the therapeutic effect of low density lipoprotein adsorption (LDL-A) in 14 patients who had focal glomerulosclerosis (FGS) with the nephrotic syndrome resistant to steroids. Patients received a total of 6 sessions (2 times a week for 3 weeks). The levels of total cholesterol, triglycerides and low-density lipoprotein were decreased significantly after treatment (by approximately 50%) in all patients (p<0.01). There also seemed to be a possibility that LDL-A improved the response to steroid therapy. The glomerular filtration rate (GFR) increased from 54.4 +/-27.4 ml/min to 70.0+/-30.2 ml/min (p <0.05) and daily urinary protein excretion (Up/day) decreased from 7.24+/-3.58 g/day to 2.56 + 2.00 g/day (p<0.01). Up/day was significantly higher in patients who showed more than 30% improvement of GFR (n = 6) than in patients who showed less than 30% improvement of GFR (n = 7) (9.50+/-3.41 g/day vs 4.59+/-1.17 g/day, p<0.05). The decrease of urinary protein excretion was more marked in younger patients (29.4+/-11.9 vs 49.7+/-14.8, p <0.05). Only electron microscopy was able to detect histological recovery in the patients who showed a decrease of proteinuria after LDL-A therapy and light microscopy was not able to verify or accurately identify the histological response. In conclusion, LDL-A seems to be effective for FGS associated with nephrotic syndrome resistant to steroids, especially in younger patients. Histological assessment of the effect of this treatment requires electron microscopic examination.